Diaphragmatic Injury with Hemothorax and Gastric Laceration Following Penetrating Thoracoabdominal Injury from Occupational Accident: A Case Report in Buea Regional Hospital

Abstract

Quincy-Jones Tchumukong Shumbang, Martin Mokake, Christian Damien Tchuisseu Ngapjang, Philippe Lingo, Marc Effila Ambassa, Bertold Brecht Kouam, Ronald Gobina, Emelinda Berinyuy Nyuydzefon and Verla Vincent Siysi

Introduction: diaphragmatic injuries are relatively uncommon and they are life-threatening because of their associated injuries. Thoracoabdominal injuries account for up 15% of diaphragmatic injuries but in Cameroon in particular it is up to 18.1%. work accident related is just up to 14.8% of diaphragmatic injuries. In penetrating mechanism, the lesion is usually small with over 80% being smaller than 2cm. however, complication from misdiagnosis even for larger lesion size can be more life-threatening and as such, thorough initial evaluation with prompt intervention is very important for a better outcome particularly in low income countries.

Case presentation: A 40-year-old male referred with thoracoabdnimal ultrasound report of 2.89cc of homogenous anechoic fluid in the Morrison pouch, from a health facility about 30km to our services after he presented there with a bleeding wound on his left lateral lower chest and left posteriolateral arm following an occupational accident (was pierced by a sickle-shape knife). He arrived at our service in respiratory distress, hemorrhagic shock and generalized peritonitis. Fluid resuscitation was done, and a left emergency thoracotomy done and which collected 300cc of dark blood, analgesics and antibiotics were administered and visible ingested food particles were seen on the chest wound. A clinical diagnosis of acute respiratory distress and hypotension secondary to diaphragmatic injury with hemothorax and gastric laceration folloowing penetrating thoracoabdominal injury was made. He was immediately rush to the theatre for exploratory laparotomy. Which reviewed a 5cm left diaphragmatic injury and 12cm gastric laceration which were sutured and peritoneal and thoracic lavage done. He was transfused 1 unit of cross match whole blood and the chest tube was removed on day 10 post-operation.

Key Clinical Massage: Diaphragmatic injury should be suspected following penetrating thoracoabdominal injury, and life- threatening injuries such as hemothorax should always be address first with simple chest tube or standard thoracotomy. Imaging investigations, should not delay immediate surgical intervention in penetrating thoracoabdominal injury with hypotension/hemorrhagic shock.

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